1. HEPATITIS MOBILE TEAM
News Tools of screening viral hepatitis in real life: the french model of care
André-Jean REMY (1,2), Hugues WENGER (1),
Hakim BOUCKHIRA (1), Stéphane MONTABONE (1),
Agnès SENEZERGUES (2)
(1) Hepatitis Mobile Team, Service of Gastroentrology,
(2)Consultation Unit and Ambulatory Care, Perpignan Hospital, France 1

2. INFECTIOUS RISK REDUCTION AMONG DRUGS USERS (DU)
EXPERT GROUP INSERM 2010
INFECTIOUS RISK REDUCTION AMONG DRUGS USERS (DU)
Recommandations :
1) Screening ALL drug users for HIV and hepatitis B and C, and also screening again at least once a year
2) Evaluating impact of advanced hepatology and infectious diseases consultations : in high and low levels methadon centers (CSAPA/CAARUD) and inmates medical unit (UCSA) and other potential places
3) Being close to DU in high and low levels methadon centers (CSAPA / CAARUD) because it appears an improvement factor for viral hepatitis diagnostic and treatment
4) Promoting access for DU to psycho-educative intervention programs outside of hospital
5) Establishing multidisciplinary outreach centers "all in one" screening to treatment, including vaccination against HBV, provide medical care and also social care 2

3. HEPATITIS MOBILE TEAM

4. 10 SERVICES « à la carte »
1. Screening / Point of Care Testing POCT (HIV HBV HCV)
2. Mobile liver stiffness Fibroscan* (indirect measurement
of liver fibrosis) in site
3. Social screening and diagnosis (EPICES score)
4. Advanced on-site specialist consultation
5. Easy access to pre-treatment commissions (“RCP”) with hepatologists, nurse, pharmacist, social worker, GP, psychiatric and/or addictologist..
6. Individual psycho-educative intervention sessions
7. Collective educative workshops
8. Staff training
9. Drug users information and prevention
10. Green thread: special outside POCT and FIBROSCAN* 4

5. Introduction
Hepatitis B and C screening was usually done by serology in laboratories or medical centers
If serology was positive, viral load and genotype was determined
patient saw hepatologist if viral load was also positive

6. Introduction (2)
Liver fibrosis was measured after first medical consultation
All steps took 3 to 6 months
Drug injection was main contamination route of hepatitis C virus (HCV) in France and western Europe since 1990
highest european screening rate in France  still 33% of patients didn’t take care of hepatitis C

7. Methods (1)
Hepatitis mobile team proposed new model of screening high risk patients for hepatitis C or B
All team members (nurses and social worker) came together in outreach centers, jailhouses, drug services centers and all structures which care drugs users, homeless or other precarious patients

8. Methods (2) triple screening in same time:
social screening with specific score of 11 questions called EPICES
POCT for HCV HBV and HIV
liver fibrosis screening by FIBROSCAN*
With this results, patient could do his/her biology quickly and see hepatologist in 2 or 3 weeks only

9. PARTNERS ORGANIZATIONS
Asyleum medical unit
Jailhouse medical unit
Primary care access unit
TB unit
Addictology service
Gastroenterology service
Medical duty home
Hospital services
people
area
One Day hospital and Psychiatric Mobile Team
Mao – psychiaitric diagnosis and orientation module
Psychiatric Hospital
HEPATITIS
MOBILE TEAM
Associative sector
Methadon centers
Low threesold drug center
Housing units
Therapeutic Coordination Apartment
Day reception and home association
Outside hospital
Patients association
Psychoeducative network
Hepatitis network 9

10. Workplaces of HMT Drug centers Jailhouse Day reception home unit
Primary care acess unit
Specific converted truck 10

11. Point Of Care Testing POCT HCV / HIV / HBV
Alternative to blood test, but in case of positive test  a blood test confirmation is necessary
Quick on digital puncture
Immediate results
Free, renewal of HCV/ HIV status as soon as necessary
Reliable 3 months after taking HIV / HCV / HBV risk Do not detect the primary infection 11

12. Results (1) 1101 POCT were done in 24 months 12% were positive for HCV
22% were positive for already known patients  who returned to medical care by this pathway
7% positive for HBV
1 POCT was positive for HIV

13. Fibroscan* 13

14. Results (2) 393 FIBROSCAN* were done medium rate of 7.8 Kpa
fibrosis level F2
68% for HCV
3% for HBV
29% for alcoholic liver disease

15. Results (3)
All patients were evaluated with specific social score EPICES (since september 2014)
11 questions yes/no
Maximal score 100
> 45.8 = precarious patients
90% of our patients were precarious…
98 patients in 9 months
311 interviews
Average 3 per patient
Maximum 15 interviews for one! 15

16. Results (4) 190 patients were followed by nurses and social worker
134 patients were addressed to on site hepatologist consultations  112 came at least once
45% of patients were treated by DAA
only 3% were lost sight

17. Patients’ words Free access Closeness (outside hopital)
Speed (of the results)
Availibility (of nurse and social workers)

18. Possible by specific trained nurses
A new clinical patient pathway?
Free services for outpatients with or without social insurance
Screening (POCT / FIBROSCAN*)
Diagnosis (biology)
Treatment (RCP)
HCV cure
New referral pathways
Possible by specific trained nurses 18

19. Conclusion a new model of care
based on site triple screening (serology, liver fibrosis, social diagnosis) and follow up
increased number of patients diagnosed, treated and cured

20. We need to provide services
that meet the needs
of high risk groups 20

21. THANK YOU FOR YOUR ATTENTION!21

22. Any questions ?